J Rural Health. 2021 Mar 23; doi: 10.1111/jrh.12572. Epub 2021 Mar 23.
Evaluating disparities in access to obstetric services for American Indian women across Montana.
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
Maggie L Thorsen, Sean Harris, Ronald McGarvey, Janelle Palacios, Andreas Thorsen
Affiliations
Affiliations
- Department of Sociology and Anthropology, Montana State University, Bozeman, Montana, USA.
- Jake Jabs College of Business and Entrepreneurship, Montana State University, Bozeman, Montana, USA.
- Department of Industrial and Manufacturing Systems Engineering and Truman School of Public Affairs, University of Missouri, Columbia, Missouri, USA.
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California, USA.
PMID: 33754411
PMCID: PMC8458487 DOI: 10.1111/jrh.12572
Abstract
PURPOSE: Pregnant women across the rural United States have increasingly limited access to obstetric care, especially specialty care for high-risk women and infants. Limited research focuses on access for rural American Indian/Alaskan Native (AIAN) women, a population warranting attention given persistent inequalities in birth outcomes.
METHODS: Using Montana birth certificate data (2014-2018), we examined variation in travel time to give birth and access to different levels of obstetric care (i.e., the proportion of individuals living within 1- and 2-h drives to facilities), by rurality (Rural-Urban Continuum Code) and race (White and AIAN people).
FINDINGS: Results point to limited obstetric care access in remote rural areas in Montana, especially higher-level specialty care, compared to urban or urban-adjacent rural areas. AIAN women traveled significantly farther than White women to access care (24.2 min farther on average), even compared to White women from similarly rural areas (5-13 min farther, after controlling for sociodemographic characteristics, risk factors, and health care utilization). AIAN women were 20 times more likely to give birth at a hospital without obstetric services and had less access to complex obstetric care. Poor access was particularly pronounced among reservation-dwelling AIAN women.
CONCLUSIONS: It is imperative to consider racial disparities and health inequities underlying poor access to obstetric services across rural America. Current federal policies aim to reduce maternity care professional shortages. Our findings suggest that racial disparities in access to complex obstetric care will persist in Montana unless facility-level infrastructure is also expanded to reach areas serving AIAN women.
© 2021 National Rural Health Association.
Keywords: American Indians; driving time; health care access; obstetrics; rural perinatal care
References
- Health Serv Res. 1983 Spring;18(1):49-74 - PubMed
- Obstet Gynecol. 2012 Mar;119(3):611-6 - PubMed
- J Perinatol. 2018 Jun;38(6):645-652 - PubMed
- J Rural Health. 2009 Fall;25(4):332-41 - PubMed
- Health Aff (Millwood). 2017 Sep 1;36(9):1663-1671 - PubMed
- Matern Child Health J. 2017 Dec;21(Suppl 1):59-64 - PubMed
- J Obstet Gynecol Neonatal Nurs. 2006 Jan-Feb;35(1):3-12 - PubMed
- J Rural Health. 2014 Fall;30(4):335-43 - PubMed
- Health Aff (Millwood). 2017 Apr 01;36(4):592-595 - PubMed
- Pediatrics. 2002 May;109(5):745-51 - PubMed
- Natl Vital Stat Rep. 2020 Jan;69(2):1-18 - PubMed
- Public Health. 2015 Jun;129(6):611-20 - PubMed
- J Environ Public Health. 2014;2014:321604 - PubMed
- Am J Public Health. 2014 Jun;104 Suppl 3:S263-7 - PubMed
- Obstet Gynecol. 2020 Apr;135(4):896-915 - PubMed
- JAMA. 2018 Mar 27;319(12):1239-1247 - PubMed
- J Rural Health. 2002;18 Suppl:233-41 - PubMed
- Am J Obstet Gynecol. 2010 Apr;202(4):335-43 - PubMed
- Am J Obstet Gynecol. 2016 May;214(5):661.e1-661.e10 - PubMed
- J Transcult Nurs. 2009 Jan;20(1):15-27 - PubMed
- Am J Obstet Gynecol. 2019 Dec;221(6):B19-B30 - PubMed
- Am J Public Health. 2010 Jan;100(1):122-8 - PubMed
- Am J Public Health. 2004 Oct;94(10):1695-703 - PubMed
- Soc Sci Med. 2019 Apr;226:143-152 - PubMed
- Can J Nurs Res. 2018 Dec;50(4):202-213 - PubMed
- Am J Public Health. 1994 Sep;84(9):1414-20 - PubMed
- Am J Obstet Gynecol. 2017 Feb;216(2):185.e1-185.e10 - PubMed
- J Community Health Nurs. 2019 Oct-Dec;36(4):165-187 - PubMed
- Am J Public Health. 2016 Aug;106(8):1463-9 - PubMed
- Am J Public Health. 2002 Sep;92(9):1491-7 - PubMed
- Am Indian Alsk Native Ment Health Res. 1998;8(2):56-78 - PubMed
- Obstet Gynecol. 2020 Feb;135(2):294-300 - PubMed
- Health Aff (Millwood). 2019 Dec;38(12):2077-2085 - PubMed
- BMC Health Serv Res. 2011 Jun 10;11:147 - PubMed
- J Transcult Nurs. 2012 Jan;23(1):29-37 - PubMed
- Am J Public Health. 1990 Jul;80(7):814-8 - PubMed
- J Health Care Poor Underserved. 2011 Aug;22(3):894-911 - PubMed
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